Cost effectiveness has always been emphasized in the healthcare industry. With an estimated of $44 billion spent annually in the US to treat depression while only 6% of the health insurance policies provide outpatient benefits for psychiatric disorders, cost effectiveness is even more urgent in the psychiatric field.
Many rating scales measuring symptoms of mental disorders and depressions have been developed over the years in order to achieve cost effectiveness in the psychiatric field. These rating scales act as check-lists for clinicians and diagnosticians, monitoring patients' responses to certain treatments or reactions to environmental changes. These rating scales generally adopt a verbal symptom description method, relying on patients to verbally describe their feelings or elect from one of the verbally-described scenarios to match their feelings. Then, these rating scales rely on clinicians or diagnosticians to `rate` the patients based on patients' responses.
Rating scales today can generally be classified into four groups: (1) for normal healthy individuals; (2) for assessing the social adjustments of patients in hospital wards; (3) for assessing patients' behaviors in hospital wards; and (4) for rating symptoms of mental illness. These ratings scales, although quite useful, have many limitations and shortcomings.
First of all, these rating scales often require verbal symptom communications, proving difficult or even impossible for alexithymic patients, trauma victims such as patients with post-traumatic stress disorder (PTSD), and patients who grew up in alcoholic or other dysfunctional families. These patients either are unable to communicate verbally, or they tend to suppress, repress, deny, or minimize their distress. These suppression mechanisms, often unconscious, may have been or may be very adaptive, ever since the patients' childhood environments. Due to these mechanisms, the verbal descriptions such patients give often lead clinicians and diagnosticians to under-diagnose their depression. Ultimately, poor treatment outcomes with relapses, or recurrences are inevitable.
Additionally, some patients might not be able to differentiate meanings between different medical terms, or they may consider themselves as treatment-resistant. Thus, eliciting verbal symptom descriptions directly from these patients often result in discrepancies and/or incorrect treatments.
Treatments for intense emotional pain, including depression subtypes and major depression with psychotic features such as mood-congruent psychotic features, mood-incongruent psychotic features, and melancholia differ significantly from treatments for uncomplicated major depressions. Thus, it is desirable to have a rating scale covering a whole range of symptoms in order to provide focused diagnosis and treatment.
However, rating scales devised specifically for rating symptoms of mental illness often cannot cover the whole range of symptoms. Even when the whole range of symptoms are covered, there are always difficulties with differentiating symptoms. This is due to the difficulty of differentiating or even defining some symptoms. For example, the term "delusion" may refer to grandiose, depressive, somatic, or even paranoid delusions which are quite different from one another and appear in different settings. Thus, after utilizing these rating scales, clinicians and diagnosticians are often left with an all-inclusive but messy, uninterpretable rating scale, or a rating scale not right-on-the-target of the patients' symptoms.
Furthermore, these rating scales usually are only devised for use on a special group of individuals. Thus, a pre-screening or a pre-diagnosis is often required prior to utilization of these scales. For example, ratings scales for normal healthy individuals do not screen for many mental disorder symptoms. In addition, such scales do not qualitatively distinguish between symptoms of mental illness and normal variations of behavior. As a result, over-diagnosis and thus over-treatment or more often the case, under-diagnosis and thus under-treatment occurs frequently.
Because these rating scales require the clinicians and diagnosticians to `rate` the patients rather than self-assessments by the patients, oftentimes, ratings amongst different clinicians and diagnosticians result in wide discrepancies. Furthermore, when the rating scales are administered by only one clinician or diagnostician, these rating scales often are biased and thus, require some scaling or redistribution which are mere statistical estimations to correct such bias.
Even when these scales are designed for self-rating, literacy and minimal legal capacity are often required. Semiliterate patients often can not utilize these self-rating scales, and seriously ill patients may not have the mental capacity or faculties to utilize such scales, either.
Accordingly, there is a need in the art for a rating scale which elicits a patient's mental health states via a non-verbal communication means directly from a patient. There is also a need in the art for quantifying these non-verbal responses in order to compare the results of successive treatment trials.
Additionally, there is a need in the art for a rating scale capable of detecting and quantifying intense emotional pain or pains including depression subtypes and major depressions with psychotic features such as mood-congruent psychotic features, mood-incongruent psychotic features, and melancholia. A rating scale is also needed to highlight situations where a substantial amount of effort should be devoted first in order to treat other illnesses.
Furthermore, there is a need in the art for a rating scale covering the whole range of depression symptoms while providing clinicians and physicians an interpretable diagnosis. In addition, there is a need in the art for a rating scale where literacy and minimal mental capacity are not required in order to use the rating scale, and bias utilizing the rating scale is minimized. Also there is a need in the art for a rating scale which can be self-administered and/or administered by a non-clinician.